The University Archives has determined that this item is of continuing value to OSU's history.Chovanec, Michael George, Ph.D., Ph.D. University of Minnesota, 1995, Marriage & Family Therapist/Adult Day Treatment Coordinator, Scott County Mental Health Center, Adjunct Faculty Member, Augsburg College - "Attrition in the Treatment of Men Who Batter: A Closer Look at Men's Decision-Making Process About Attending or Dropping Out of Treatment"The Ohio State University College of Social Wor

Chovanec, Michael George

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Attrition in the Treatment of Men Wbo Batter:A Closer Look at Men's Decision-Making ProcessAbout Attending or Dropping Out of TreatmentMichael George Chovanec, Ph.D.Ph.D., University of Minnesota, 1995Marriage & Family Therapist/Adult Day Treatment CoordinatorScott County Mental Health CenterAdjunct Faculty Member, Augsburg CollegeStatement of the Research ProblemAn estimated 1.8 million spouses are beaten every year and conjugal murders accountfor between 15 % to 25 % of all homicides committed in the United States (Edleson, 1985). Aspart of the public response to this problem, some 195 treatment programs were developed. formen who batter by the mid 1980's (Pirog-Good & Stets-Kealey, 1985). Attrition is a majorproblem reported by many of these programs and has been linked to future abuse.Roberts (1982) found attrition to be the most frequently identified by programsresponding to an early national survey (34 % or 15 programs). Pirog-Good and Stets-Kealey(1985) reported that 60% of 59 programs surveyed identified attrition as a major problem.Similarly, Deschner (1984) reported in his survey of 90 programs that one-third to one-half ofbatterers drop out after the first counseling session.Recent outcome studies suggest that women whose partners have dropped out of treatmentare at a higher risk of experiencing future physical abuse than those whose partners remain intreatment. Edleson and Gruszunski (1988), reported that 67% who completed the program werenon-violent at the at time of follow-up, compared to 54 % who did not complete the program.Shupe, Stacey & Hazelwood (1987) reported that 80% of treatment completers were not violentat follow-up, compared to 55 % of the drop-outs.Women often return to batterers when their partners enter a treatment program, andusually are unaware of the high probability that their partners will drop out. This in turn placesthe women at a higher risk of future abuse, living with partners who dropped out of treatment.Gondolf (1988) reported that the batterer being in counseling was the most influential predictorin determining which women would return to their batterers.Nineteen client characteristics were found to influence attrition in domestic abusetreatment but no one variable was found to consistently predict treatment completion/dropoutacross all studies (Hamburger & Hastings, 1986, 1989; DeMaris, 1989; Gruszunski & Carrillo,441988; Saunders & Parker, 1989). Major gaps in the research on attrition in domestic abusetreatment have included the lack of theoretical framework(s) to help guide the search forvariables of predictive value, an absence of data on the involuntary nature of the intake process,and the decision-making of how potential clients decide to comply or drop out of treatment.The theoretical frameworks of Planned Behavior and Reactance were specifically selectedand operationalized in this study to address the limitations of previous research. Reactance, aconstruct which examines a person's response to a coercive environment was operationalized byDowd, Milne, and Wise (1991), and a newly developed five-item instrument applying ReactanceTheory to a domestic abuse setting. The Theory of Planned Behavior examines the decision-making process through three attitude constructs, attitude towards behavior, subjective norm,and perceived behavior control. The theory suggests that these attitude constructs influenceone's intentions to complete a specific behavior, which was in this study, completing or droppingout of treatment. The theory suggests one's intentions should predict treatment completion. Thetheory was operationalized in the domestic abuse treatment setting by a series of belief andattitude scales.Research OuestionsTo what extent do the variables of past research differentiate between completers anddropouts of domestic abuse treatment in this study? To what extent is reactance present in menreferred to domestic abuse treatment? What is the relationship between reactance andcompleting or dropping out of domestic abuse treatment? What is the predictive power of theTheory of Planned Behavior in predicting which men complete or drop out of domestic abusetreatment? What are the best predictors of treatment completers or dropouts when combiningvariables from both theories, and the descriptive variables identified in previous research ondomestic abuse attrition?MethodologyInstruments were operationalized from the theories of Planned Behavior and Reactance,using indiCators pertinent to a domestic abuse treatment setting. Aftercare groups from two localdomestic abuse treatment programs provided feedback on the development of the newinstruments. Once the study was completed, an inter-item reliability analysis was run to providea measure of reliability for each instrument.The study was then implemented at one of the local domestic abuse treatment programs usedin the development of the new instruments. A collection of instruments were given to studyparticipants once they had completed orientation. These instruments measured the reactance andplanned behavior variables as well as variables found to influence attrition in earlier studies,such as age, employment status, and education. Once men had either completed or dropped outof domestic abuse treatment, men's responses on this collection of variables were compared45between completers and dropouts.The T-test and Chi-Square statistics were used to identify continuous and categoricalvariables that were significantly different between completers and drop-outs of domestic abusetreatment. The T-test was also used to assess the significance of the level of reactance reportedby men entering domestic abuse treatment.Multiple regression was chosen to assess the predictability of the variables measured in thestudy. This type of regression was chosen since earlier studies applying the Theory of PlannedBehavior used a similar analysis, thus results could more easily be compared between this studyand others. A continuous variable is typically used in this type of regression, however,dichotomous dependent variables (in this case, completers and dropouts of treatment) can be usedas long as numbers in either category are not more than a 4: 1 ratio (Cleary & Angel, 1984).Since the study sample was highly skewed towards dropouts, 74.6% of the total sample,logistic regression was also used to address the prediction question. In this study logisticregression predicts the odds of men completing treatment versus not completing by assessingPlanned Behavior, Reactance and demographic variables.ResultsOut of the one-hundred and twenty-one men who completed the study surveys anddemographic sheet, 25.4% (30 men) completed the program, and 74.6% (88 men) dropped out,from the orientation through completion of the program. The descriptive variables found todifferentiate between completers and dropouts included the following: employment, familyincome, witnessing physical abuse between parents, frequency of chemical dependency treatmentand court order. Men who were employed, had higher incomes, witnessed abuse betweenparents, did not participate in chemical dependency treatment, and were court ordered, weremore likely to complete treatment.Significantly higher mean scores on the Therapeutic Reactance scale (Dowd, Milne andWise, 1991) were reported by men in this study sample, compared to college students used todevelop the original instrument. Men's mean scores on the newly developed reactance scalewere significantly higher for completers than for dropouts. The Therapeutic Reactance Scale(Dowd, Milne and Wise, 1991) did not significantly differentiate between completers anddropouts.In predicting intentions, using multiple regression, the combined attitude scales ofPlanned Behavior, attitude toward behavior, subjective norm, and perceived behavioral controlproduced an adjusted R-square of .30. In predicting behavior, in the same regression analysisthe adjusted R-square dropped to .02, with only intentions contributing to the equation. Usinglogistic regression intentions remained in the equation and predicted 74.58 % of the study46participants, but only dropouts were predicted.Variables with the highest predictive power were identified. Using multiple regression,adjusted R-squares ranged from .02 for Planned Behavior variables to .21 for combinedtheoretical and descriptive variables. Using logistic regression, the best overall prediction was69% with both completers and dropouts predicted. Both reactance and witnessing abuseremained in the final equation.Utility for Social Work PracticeThis study was one of the first to test the utility of using theoretical frameworks inaddressing the problem of attrition, rather than haphazard groupings of variables such as arecurrently found in the attrition research. Reactance was not only found to be highly reportedin the study sample, but also was found, with the newly developed reactance instrument, todifferentiate between completers and dropouts. With more work on the instrument to increasereliability (alpha = .59), the instrument could be used as a screening tool to identify those menmost likely to drop out.The fact that completers had higher reactance scores in this study than dropouts suggestsreactance combined with legal or social sanctions to complete treatment may serve to help menengage in the treatment process. Clinical judgement suggests reactance levels are reduced oncemen begin identifying with other group members and material presented in the program.However, this has yet to be confirmed by research. This finding raises several questions. Whathappens to reactance as men move through the treatment process? What impact does highreactance have on men changing their abusive beliefs/behaviors?The variables of court order, family income, employment status, frequency of chemicaldependency treatment, and witnessing abuse between parents, found to significantly differentiatebetween completers and dropouts, could be used to build a list of risk markers for men enteringtreatment. For example, treatment programs could target men entering treatment who areunemployed and/or have low family income, are not court ordered, and did not witness abusebetween parents.This study took a number of risks in implementing theoretical frameworks that had neverbeen operationalized in a domestic abuse treatment setting before. Hopefully it has laid theground for further research applying these theories and others, to better address the problem ofattrition and develop guidelines that will improve the treatment for men who batter.47ReferencesCleary, P.D., and Angel, R. (1984). the analysis of relationships involving dichotomousdependent variables. Journal of Health and Social Behavior,25, 334-348.DeMaris, A. (1989), Attrition in batters' counseling: The role of social and demographicfactors. Social Service Review,63, March, 142-154.Deschner, J.P, (1984). The hitting habit: Anger control for battering couples, New York: FreePress.Dowd,T., Milne, C.R, and Wise, S.L. (1991). The therapeutic reactance scale: A measure ofpsychological reactance. Journal of Family Issues, 6, 229-247.Edleson, J,L., Eisikovitis, Z,C. and Guttman, E. (1985). Men who batter women: A criticalreview of evidence. Journal of Family Issues, 6, 229-247,Edleson, J.L. and Grusznski, R.J. (1988). Treating men who batter: Four years of outcome datafrom the Domestic Abuse Project. Journal of Social Service Research, 12, 1,3-22.Gondolf, E.W. (1988). The effect of batterer counseling on shelter outcome. Journal ofInterpersonal Violence, 3, 3, September, 275-289.Gruszinski, R.J. and Carrillo, T.P. (1988). Who completes batterers' treatment groups? Anempirical investigation. Journal of Family Violence,3, 2, 141-150.Hamberger, K.L. and Hastings, J.E. (1986). Characteristics of spouse abusers, Predictors oftreatment acceptance. Journal of Interpersonal Violence,1.3, September, 363-373.Hamberger, K.L. and Hastings, J.E, (1989). Counseling male spouse abusers: Characteristicsof treatment completers and dropouts. Violence and Victims, 4, 4, 275-286.Pirog-Good, M.A. and Stets-Kealey, J. (1985). Male batterers and battering preventionprograms. A national survey. Response to Victimization of Women and Children, 8,3,Summer, 8-12.Roberts, A.R. (1982). A national survey of batterers. In M. Roy (Ed.), The abusive partner(p.230-243), New York: Von Nostrand,Saunders, D.G. and Parker, J.C. (1989). Legal sanctions and treatment follow through amongmen who batter. A multi variate analysis. Social Work Research and Abstracts, 25, 21-29.Shupe, A., Stacey, W.A. and Hazelwood, L.R. (1987). Violent men, violent couples.Lexingtion, MA: Lexington Books.48

Attrition in the Treatment of Men Who Batter: A Closer Look at Men's Decision-Making Process About Attending or Dropping Out of Treatment

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Attrition in the Treatment of Men Who Batter: A Closer Look at Men's Decision-Making Process About Attending or Dropping Out of Treatment

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